Management of acute contrast media reactions in children

Question 1

IV contrast media dose in children

Answer 1

2-3 ml of 280-300 mg I/ml per Kg body weight to a maximum of 150 ml in those weighing >50kg

Question 2

Urticaria

Answer 2

1. no treatment needed in most cases
2. give diphenhydramine 1-2 mg/kg IM/IV/PO up to 50 mg
3. severe and widely disseminated: epiniphrine 0.01 ml/kg (1:1,000) SC or IM

Question 3

Facial Edema

Answer 3

1. give o2 at 6 - 10 liters/min via face mask , face tent, blow by stream
2. monitor ecg, bp, o2 sat
3. give epiniphrine (1:1,000) SC or IM 0.01 ml/kg up to 0.3ml/dose. repeat every 15-30 minutes as needed.
4. give diphenhydramine IM/IV 1-2 mg/kg up to 50 mg.
5. if not responsive seek help

Question 4

Laryngeal Edema or Bronchospasm

Answer 4

1. give o2 at 6-10 liters/min via face mask, face tent, blow by stream
2. monitor v/s ecg, bp, o2 sat
3. give epiniphrine (1:1,000) 0.01ml/kg up to 0.3ml/dose OR epiniphrine (1:10,000) IV 0.1ml/kg max dose of 3.0ml/dose repeat 3-5 minutes as neede.
4. give beta agonists inhalers: TERBUTALINE, SALBUTAMOL 2-3 puffs repeat as needed.
5. call for assistance fro severe spasms o2 sat

Question 5

Pulmonary Edema

Answer 5

1. give o2 at 6-10 liters/min
2. monitor v/s
3. give diuretic: FUROSEMIDE 1-2 mg/kg IV
4. call for assistance.

Question 6

Hypotension with tachycardia

Answer 6

1. give o2 at 6-10liters/min
2. monitor ecg, o2sat, bp
3. trendelenburg position
4. keep pt warm
5. give IV or IO normal saline or Ringer’s lactate 20ml/kg over 5-10 minutes; bolus infusion over 10-20 minutes in patients with myocardial dysfunction.
6. seek appropriate help

Question 7

Hypotension with bradycardia

Answer 7

1. give o2 at 6-10 liters/min
2. monitor: ecg, bp. o2 sat
3. elevate legs at 60deg or trendelenburg position
4. keep patient warm
5. give IV or IO normal saline or Ringer’s lactate 20 ml/kg over 5-10 minutes. Give infusion over 10-20 minutes in patients with myocardial dysfunction
6. give ATROPINE IV 0.02mg/kg if patient does not respond quickly to steps 2345. minimum initial dose of 0,1 mg, maximum dose of 0.5 mg (infant/child) 1 mg(adoescent).
7. Atropine dose may be doubled for second administration
8. seek appropriate assistance.